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General NPI Number Information
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NPI Number | 1366154957
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Entity Type | Individual
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Provider Name | HEATHER A TELLER PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 2244 EXECUTIVE DR
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City | HAMPTON
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State | VA
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Zip | 23666-2430
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Country | US
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Telephone | 757-827-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 5372 WILLIAM EARL WAY
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City | GLOUCESTER
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State | VA
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Zip | 23061-3602
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Country | US
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Telephone | 804-854-1003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024185805
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License Number State | VA
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